Esophageal Banding

Can Banding Treat Esophageal Varices?

Esophageal varices are enlarged veins in the esophagus. Most people with cirrhosis have esophageal varices. In cirrhosis, blood flow through the liver is reduced and this blood flow gets diverted towards the stomach, esophagus, spleen and hemorrhoids.  Because of this increased blood flow to those regions, these veins become engorged with blood. This increased blood flow places the patient at a high risk for bleeding. In some cases these veins can rupture and lead to massive gastrointestinal bleeding.

Esophageal variceal banding can prevent and or decrease the risk of bleeding. A doctor can use an endoscope to wrap bands around these veins in order to prevent or stop bleeding. See your doctor if you think you may benefit from banding treatment.

Hemorrhoid Banding

Can Banding Treat Internal Hemorrhoids?

Internal hemorrhoids are common and sometimes bothersome to patients. Hemorrhoids can lead to pain in the rectum along with bleeding. Hemorrhoid banding is a safe and effective way to treat this problem once all other medical treatments have failed.

Breath Tests

Breath Test For Bacterial Overgrowth

The indication: Although there are normally lots of bacteria in the large intestine, the small intestine normally contains far less bacteria because stomach acid prevents bacteria from growing and because food is rapidly moved through it. However, certain conditions can allow bacteria to grow in the small intestine, such as low stomach acid, a parasite infection, intestinal scar tissue, diabetes, Crohn’s disease and slow transit of food through the intestine. Bacteria in the small intestine can cause bloating/gas and possible diarrhea within one hour of eating. Unexplained weight loss and Vitamin B12 deficiency are other clues to bacterial overgrowth.

The test: To perform the test, the patient takes a drink containing the sugar lactulose. If there is bacteria overgrowth in the small intestine, lactulose will ferment, producing the gases hydrogen and methane. The breath test involves blowing into a mouthpiece, which collects the breath into vacuum-sealed collection tubes. It looks for increased hydrogen and methane in the exhaled breath. The more of these gases present, the greater the degree of bacterial overgrowth.

Breath Test For Lactose Intolerance

The indication: Lactose intolerance is the inability to digest lactose, the sugar found in milk. It causes cramping, bloating, gas, or diarrhea any time dairy products are consumed. Lactose intolerance occurs due to the body’s lack of lactase, an enzyme normally produced by the small intestine that is needed to digest lactose.

The test: To perform the test, the patient takes a drink containing lactose. The beverage may cause cramping, bloating, gas, or diarrhea. If you are lactose intolerant then your body will not be able to break down the lactose and the undigested lactose will instead be fermented by bacteria in the colon, releasing hydrogen. The released hydrogen will be absorbed into the bloodstream and eventually excreted in the breath. The breath test involves blowing into a mouthpiece, which collects the breath into vacuum-sealed collection tubes. It looks for increased hydrogen and methane in the exhaled breath.

Breath Test For H. Pylori

The indication: Helicobacter pylori, abbreviated as H. pylori, is a bacteria that can infect the stomach or duodenum (first part of the small intestine). If left untreated, H. pylori bacteria can cause gastritis (an inflammation or irritation of the stomach lining) and duodenal or gastric ulcers. In addition, infection with H. pylori increases the risk of other diseases and is also a risk factor for gastric cancer.

The test: To perform the test, the patient either swallows a capsule or drinks a beverage containing specially-labeled urea. If H. pylori is present in the stomach, the urea is broken up and turned into carbon dioxide. The carbon dioxide is absorbed across the lining of the stomach and into the blood. It then travels in the blood to the lungs where it is excreted in the breath. Samples of exhaled breath are collected, and the isotopic carbon in the exhaled carbon dioxide is measured.

Breath Test for Fructose & Sorbitol Malabsorption

The indication: Fructose is known as the ‘fruit sugar’ but it’s found in many other foods. Some people cannot absorb fructose and develop gas, bloating and diarrhea.
The test: The patient takes a drink containing fructose and then blows into a mouthpiece which collects the breath in a vacuum sealed collection tube. It looks for increased hydrogen in the exhaled breath.

The indication: Sorbitol is mostly found as an artificial sweetener and is poorly absorbed by most people leading to gas, bleeding and diarrhea.
The test: The patient takes a drink containing soribtol and then blows into a mouthpiece which collects the breath in a vacuum sealed collection tube. It looks for increased hydrogen in the exhaled breath.

Capsule Endoscopy

What is a Capsule Endoscopy?

A capsule endoscopy is a non-invasive procedure that examines the lining of your small intestine. This is done if the EGD and colonoscopy fail to find an answer to the patient’s problem. Reasons for capsule endoscopy include: diarrhea, unexplained weight loss, anemia, gastrointestinal bleeding or abdominal pain (if it has not been found on EGD or colonoscopy).

During the capsule endoscopy procedure you will swallow a small pill with a tiny camera built inside. This camera will take multiple pictures every second. A signal will transmit to a monitor that the patient will be wearing. It will take approx 8 hours for the camera to completely pass through your system. The patient does not have to stay in the doctor’s office for this procedure nor do they have to retrieve the pill. The patient will however need to return the recording belt device at the end of the day. At that time the device will be downloaded onto a computer for the doctor to review.

In general, the risks of capsule endoscopy are minor; however, the most serious risks include retention of the capsule and development of small bowel obstruction as a result of the capsule. This is especially important for those who have had prior abdominal surgeries.

Colonoscopy

What is a Colonoscopy?

A colonoscopy is an examination of the entire length of a patient’s large intestine to look for signs of colon cancer, remove colon polyps, and treat diverticular bleeding or symptoms causing constipation or diarrhea. If you are experiencing diarrhea, constipation, abdominal pain or rectal bleeding, please consult your gastroenterologist to perform a colonoscopy.

Standard of care for colon cancer screenings begin at 50 years old. However, if there is a first degree family member (mother/father/brother/sister) with colon cancer, screening should start at 40 years old or 10 years prior to when the family member was diagnosed with colon cancer or whichever comes first. African Americans need to start colon cancer screening at 45 years old.

How is a Colonoscopy Performed?

A traditional colonoscopy procedure is approximately 30 minutes in length. The colonoscopy procedure is done with a colonoscope, a flexible, tube-shaped device about four feet long and less than one inch in diameter. At the end of the colonoscope there is a fiber-optic light and miniature camera, which allows the doctor to capture images of the inside of a patient and display them on a television.

The colonoscope is inserted into the rectum and advanced to the end of the colon. At this point the colonoscope is slowly withdrawn. If polyps are detected they are removed by a small snare or forceps, which is placed through the colonoscope.

How Will I Feel During My Colonoscopy?

Patients are mildly sedated in ‘twilight’. Sometimes there can be gas and/or cramping post procedure, but this is typically minimal, if it occurs at all.

Upper Endoscopy/EGD

What is Upper Endoscopy/EGD?

Esophagogastroduodenoscopy, or EGD, is an endoscopic examination of the esophagus, stomach and duodenum (the uppermost part of the small intestine) for hiatal hernias, ulcers, bleeding sources, tumors or other problems. The procedure can also offer a number of therapeutic interventions such as control of bleeding, manometry or dilation. The procedure’s medical name is actually a combination of names of three different procedures that are usually performed collectively:

  • Esophagoscopy: Looking inside the esophagus for hiatal hernias, polyps, strictures, etc.
  • Gastroscopy: Looking inside the stomach for ulcers, polyps, inflammation, etc.
  • Duodenoscopy: Looking inside the duodenum for inflammation or ulcers.

Your Gastroenterologist may perform an EGD if you have any of the following: difficulty swallowing, black or bloody stools, vomiting blood, upper abdominal pain, unexplained chest pain, heartburn/acid reflux, nausea and/or vomiting.

What Happens During an Upper Endoscopy/EGD Procedure?

After the patient is adequately sedated, a flexible device called an endoscope is inserted into their throat and guided downward through the gastrointestinal tract, all the way to the duodenum. There is a small fiber-optic light and camera attached to the endoscope’s tip, which gives the doctor a view of the inner lining of the GI tract while the endoscope passes through.

The entire process takes no more than 20 minutes. This is a safe and typically painless procedure.

How Do I Prepare for an Upper Endoscopy/EGD?

Your upper GI tract—the esophagus, stomach and duodenum—must be empty if you want the EGD to produce accurate results. Food remaining in the tract can get in the way of the doctor’s examination and can look like something suspicious. To empty your upper GI tract, simply stop eating food and drinking beverages for 8 to 12 hours before the EGD. Also note, that you will not be able to eat or drink anything for a couple of hours after the EGD as well, because if you eat while sedated you might choke without feeling or noticing it.